Provider Demographics
NPI:1255571113
Name:ZHURAVKOVA, SVETLANA (DDS)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:ZHURAVKOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SEAWARD RD
Mailing Address - Street 2:#5
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2670
Mailing Address - Country:US
Mailing Address - Phone:310-993-3742
Mailing Address - Fax:
Practice Address - Street 1:401 SEAWARD RD
Practice Address - Street 2:#5
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2670
Practice Address - Country:US
Practice Address - Phone:310-993-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice